The Centers for Medicare & Medicaid Services (CMS) has what is referred to as a 3-day payment window. The 3-day payment window is a hospital policy but applies to physician practices that are wholly owned or operated by a hospital.
The 3-day payment window applies to services provided to Medicare patients by physicians enrolled in the Medicare program. Clinically related preadmission services, with the same or different diagnosis, performed and provided by a physician within the 3-day payment window are paid at a reduced rate.
The 3-day payment rule does not apply
Why do we tell you about this? It is unknown if Medicaid programs will follow suit and adopt this rule.
A new Healthcare Common Procedure Coding System Level II modifier (PD) has been established to identify services that are provided within the 3-day window.
The CMS has recommended that hospital-owned or hospitalcontrolled practices hold claims for...